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Plöger R, Condic M, Ralser DJ, Plöger HM, Egger EK, Otten LA, Mustea A. Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion-Case Report and Review of the Literature. J Clin Med 2023; 12:5923. [PMID: 37762865 PMCID: PMC10531937 DOI: 10.3390/jcm12185923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine green (ICG) angiography has been shown to sufficiently reflect tissue perfusion with a potential impact on the surgical procedure. Currently, there are only sparse data available on the utilization of ICG in the surgical treatment of ovarian torsion. Here, we describe the successful intraoperative use of ICG in a 17-year-old female patient with ovarian torsion who underwent ovary-preserving surgery. Further, a systematic literature review was performed. Based on the data available to date, the use of ICG in the surgical treatment of ovarian torsion is feasible and safe. The extent to which this might reduce the necessity for oophorectomy has to be evaluated in further investigations.
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Affiliation(s)
- Ruben Plöger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Mateja Condic
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Damian J. Ralser
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Hannah M. Plöger
- Department of Paediatrics, University Hospital Bonn, 53127 Bonn, Germany;
| | - Eva K. Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Lucia A. Otten
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Shwyiat R, Taso OA, Al-Edwan F, Khreisat B, Al-Dubees A. Retrospective analysis of patients with surgically proven ovarian torsion, our experience. J Family Med Prim Care 2023; 12:637-643. [PMID: 37312776 PMCID: PMC10259567 DOI: 10.4103/jfmpc.jfmpc_1450_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 06/15/2023] Open
Abstract
Aim To study the patients who were admitted to our hospital with surgically proven ovarian torsion and were operated for the same and to study for whom detorsion was done. Materials and Methods A retrospective analysis of the medical records and surgical notes of 150 patients with surgically proven ovarian torsion over a 10-year period between January 2011 and January 2021 was carried out. Surgical notes included details like mode of the surgery (laparotomy or laparoscopy), type of surgery (oophorectomy, detorsion, detorsion with cystectomy), whether fixation was done or not, size of mass/ovary, laterality, appearance of the torted ovary, color of the ovary, and number of twists. Histopathologic reports of the patients who underwent oophorectomy or detorsion with cystectomy were also recorded. Results During the 10-year study period, 88 (58.7%) patients had undergone laparotomy and 62 (41.2%) patients had undergone laparoscopy. Detorsion with cystectomy was done in 96 (64%) cases, detorsion alone in 14 (9.3%) cases, and oophorectomy was done in 40 (26.6%) cases. There was no significant difference in terms of increase in postoperative complications. Conclusion Laparoscopic detorsion with cystectomy is the most common surgical procedure used for ovarian torsion at King Hussein Medical Center.
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Affiliation(s)
- Rami Shwyiat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Omar A. Taso
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Fatima Al-Edwan
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Basel Khreisat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Ammal Al-Dubees
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
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Petrozza JC, Fitz V, Bhagavath B, Carugno J, Kwal J, Mikhail E, Nash M, Barakzai SK, Roque DR, Bregar AJ, Findley J, Neblett M, Flyckt R, Khan Z, Lindheim SR. Surgical approach to 4 different reproductive pathologies by 3 different gynecologic subspecialties: more similarities or differences? Fertil Steril 2023; 119:377-389. [PMID: 36574916 DOI: 10.1016/j.fertnstert.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Affiliation(s)
- John C Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bala Bhagavath
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Moawad Nash
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dario R Roque
- Division of Gynecologic Oncology, Feinberg School of Medicine, Northwestern University
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Michael Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, University of Central Florida, Orlando, Florida; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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5
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Garde I, Paredes C, Ventura L, Pascual MA, Ajossa S, Guerriero S, Vara J, Linares M, Alcázar JL. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:310-324. [PMID: 35751902 DOI: 10.1002/uog.24976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. METHODS This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. RESULTS The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. CONCLUSIONS The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Garde
- Department of Obstetrics and Gynecology, Hospital Universitario de Cruces, Bilbao, Spain
| | - C Paredes
- Department of Obstetrics and Gynecology, Hospital Materno-Infantil, Badajoz, Spain
| | - L Ventura
- School of Medicine, University of Navarra, Pamplona, Spain
| | - M A Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Institut Universitary Dexeus, Barcelona, Spain
| | - S Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - J Vara
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - M Linares
- Department of Obstetrics and Gynecology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Topcu A, Ozturk A, Deniz E, Duman Ozturk S, Arpa M, Atak M. The effects of amiodarone in ovarian injury due to oxidative stress and inflammation caused by ischemia-reperfusion. Immunopharmacol Immunotoxicol 2022; 44:1022-1031. [PMID: 35838634 DOI: 10.1080/08923973.2022.2102991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Ovarian ischemia constitutes 2-3% of all gynecological emergencies. New-generation therapeutic agents need to be discovered, in addition to invasive interventions capable of reducing the risk of potential ovarian ischemia to a minimum and protecting against potential adverse outcomes. AIMS To investigate the effects of amiodarone (AMD) on ischemia-reperfusion-induced oxidative stress and inflammation-induced ovarian damage. METHODS The control group, received intraperitoneal (i.p.) injection of saline solution. The ischemia group (I-Group), was subjected to ischemia-induced injury without drug administration. The ischemia + AMD (50 mg/kg) group was subjected to ischemia injury and also received i.p. 50 mg/kg AMD prior to induction of ovarian ischemia. The ischemia-reperfusion (I/R group) was exposed to ischemia and reperfusion-induced injury without drug administration. The I/R + AMD (50 mg/kg) group underwent I/R injury together with i.p. administration of 50 mg/kg AMD prior to induction of ovarian I/R. The Sham + AMD group received intraperitoneal (i.p.) injection of 50 mg/kg AMD alone. In this study performed thiobarbituric acid reactive substances (TBARS), thiol (-SH), interleukin 1 Beta (IL-1β), interleukin 6 (IL-6), toll-like receptor 4 (TLR4) and nuclear factor-kappa B(NF-κβ). RESULTS Increased oxidative stress and inflammation as a result of ovarian I and I/R application activated the cascade. AMD was not sufficient to reduce the oxidative stress and inflammation. TLR4 and NF-kβ, which were up-regulated by triggering oxidative stress and inflammation, were not regressed by the effects of AMD. CONCLUSIONS AMD, used as an antiarrhythmic agent, was found to be insufficient, despite its antioxidant and anti-inflammatory properties, to reduce the experimentally induced ovarian tissue damage.
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Affiliation(s)
- Atilla Topcu
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Aykut Ozturk
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Esra Deniz
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seda Duman Ozturk
- Department of Pathology, Recep Tayyip Erdogan University Education and Research Hospital, Rize, Turkey
| | - Medeni Arpa
- Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehtap Atak
- Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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Kumar S, Nepal P, Kumar D, Tirumani SH, Nagar A, Ojili V. Twists and turns in acute abdomen: imaging spectrum of torsions and volvulus. Clin Imaging 2022; 87:11-27. [DOI: 10.1016/j.clinimag.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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8
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Testicular Torsion Appearance and Diagnosis on Computed Tomography of the Abdomen/Pelvis: Case Report. Clin Pract Cases Emerg Med 2022. [DOI: 10.5811/2022.2.55315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Testicular torsion, or the twisting of the spermatic cord compromising blood flow to the testis, is a urologic emergency with the potential to cause infertility in male patients. The diagnosis may be clinical or confirmed using imaging, with ultrasound being the modality of choice.
Case Report: We present a case of right lower quadrant pain with radiation to the groin and right scrotum in a young male. A computed tomography of the abdomen and pelvis was ordered to assess for appendicitis, which showed a “whirl” sign on the inferior periphery of the images near the scrotum. The finding was not appreciated during the emergency department visit and the patient was discharged home. He returned 48 hours later due to continued pain and was ultimately diagnosed with testicular torsion via ultrasound and surgical pathology.
Conclusion: This is the first reported case to our knowledge identifying “whirl” sign for the diagnosis of testicular torsion. This finding was not appreciated by multiple clinicians during the initial patient presentation, highlighting the uncommon nature of the finding.
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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Ovarian torsion. Am J Emerg Med 2022; 56:145-150. [PMID: 35397355 DOI: 10.1016/j.ajem.2022.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ovarian torsion is a rare, frequently misdiagnosed condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of ovarian torsion, including presentation, evaluation, and management in the emergency department (ED) based on current evidence. DISCUSSION Ovarian torsion is one of the most common gynecological surgical emergencies and occurs with complete or partial rotation of the ovary along the supporting ligaments, obstructing vascular flow. Several risk factors include the presence of an ovarian mass or cyst. The most common population affected includes reproductive aged women, though cases also occur in premenarchal females, pregnant women, and postmenopausal women. Abdominal or pelvic pain is common but is not always sudden in onset or severe. Nausea and vomiting occur in 70%. Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Computed tomography with intravenous contrast can assist with diagnosis. Treatment includes emergent gynecologic consultation for surgical detorsion, along with symptomatic therapy in the ED. CONCLUSIONS An understanding of ovarian torsion can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Çolak S, Koc K, Yıldırım S, Geyikoğlu F. Effects of boric acid on ovarian tissue damage caused by experimental ischemia/reperfusion. Biotech Histochem 2022; 97:415-422. [DOI: 10.1080/10520295.2021.2012823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Suat Çolak
- Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Kubra Koc
- Department of Biology, Faculty of Science, Atatürk University, Erzurum, Turkey
| | - Serkan Yıldırım
- Department of Pathology, Faculty of Veterinary, Atatürk University, Erzurum, Turkey
| | - Fatime Geyikoğlu
- Department of Biology, Faculty of Science, Atatürk University, Erzurum, Turkey
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Ovarian Torsion in Adolescents with and without ovarian mass: A Cross-sectional Study. J Pediatr Adolesc Gynecol 2021; 34:857-861. [PMID: 34044177 DOI: 10.1016/j.jpag.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT). DESIGN Retrospective cross-sectional study. SETTING Gynecology Department at Tepecik Education and Reseach Hospital, Izmir, Turkey. PARTICIPANTS Adolescent girls who received surgery for OT between March 2012 and October 2020 in our institution. INTERVENTIONS AND MAIN OUTCOME MEASURES The patients were divided into 2 groups according to the presence or absence of an ovarian mass and compared. Demographic and clinical characteristics, imaging findings, surgery, and pathology reports of the patients were obtained. Differences in initial symptoms, ultrasound findings, the diagnostic process, and the degree of torsion in patients with and without ovarian mass. RESULTS Seventy-six patients were diagnosed with OT. Of the 76 patients, 41/76 (53.9%) had an ovarian mass (OTwM), and 35/76 (46.1%) had no pathology (OTnP). The admission to surgery interval was longer in the OTnP group (P = .03). Ultrasound findings of ovarian edema and the appearance of free fluid were significant in the OTnP group (P = .001). The largest dimension of the nontorsion ovary in the OTnP group was greater than in the OTwM group (P = .03). In addition, it was found that torsion more than 360° was more common in the OTnP group than in the OTwM group (24/35, 68.5% vs 41/18, 43.9%; P = .03). CONCLUSION In symptomatic adolescents without an ovarian mass, the presence of follicle peripheralization suggesting ovarian edema on ultrasound and the presence of free fluid in the abdomen are important in terms of suspicion of torsion for clinicians. In addition, the degree of torsion was increased in these patients.
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Adu-Bredu TK, Arkorful J, Appiah-Denkyira K, Wiafe YA. Diagnostic value of the sonographic whirlpool sign in the diagnosis of ovarian torsion: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:746-753. [PMID: 34021602 DOI: 10.1002/jcu.23021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/05/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
In this review, we investigated the diagnostic value of the sonographic "whirlpool sign" in identifying ovarian torsion. This was done by performing a search in PubMed, Scopus, Embase, Web of Science, CINAHL, and Google scholar. Additional search for the grey literature was made in EThOS.bl.uk, explore.bl.uk, opengrey.eu, greylit.org, and clinicaltrials.org. A total of eight studies were included in this meta-analysis. Sensitivity and specificity of whirlpool sign were extracted from the studies and computed into the Metadisc statistical software for pooled analysis. The whirlpool sign showed a high sensitivity and specificity for the diagnosis of ovarian torsion.
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Affiliation(s)
- Theophilus Kofi Adu-Bredu
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Arkorful
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Appiah-Denkyira
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Incidence of Adnexal Torsion in the Republic of Korea: A Nationwide Serial Cross-Sectional Study (2009-2018). J Pers Med 2021; 11:jpm11080743. [PMID: 34442387 PMCID: PMC8398360 DOI: 10.3390/jpm11080743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study aimed to evaluate the incidence and risk factors of adnexal torsion (AT) in the Korean population from 2009 to 2018 (10 years). Methods: We analyzed the 2009−2018 data obtained from the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. AT was identified by both diagnosis codes and surgery codes of adnexal surgery. Results: A total of 6,262,910 women were recorded in the database. The incidence of AT was 6 per 100,000 women (95% confidence interval (CI), 6−6). The incidence of AT tended to decrease with age after peaking in the late 20s to early 30s. In the weighted logistic regression analysis, women of childbearing age, especially in their 20s and 30s, had the highest AT incidence. Corpus luteal cyst (p < 0.001) and benign neoplasm (p < 0.001) increased the incidence of AT. Low socioeconomic status (SES), Charlson comorbidity index (CCI), and pregnancy were unrelated to AT. Conclusion: The incidence of AT is 6 per 100,000 women and peaks in the 20s to early 30s.
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Trinci M, Danti G, Di Maurizio M, Tursini S, Briganti V, Galluzzo M, Miele V. Can contrast enhanced ultrasound (CEUS) be useful in the diagnosis of ovarian torsion in pediatric females? A preliminary monocentric experience. J Ultrasound 2021; 24:505-514. [PMID: 34176094 DOI: 10.1007/s40477-021-00601-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/29/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe contrast enhanced ultrasound (CEUS) characteristics of ovarian torsion in pediatric females, assessing the potential diagnostic advantages of method as well as its limitations. MATERIALS AND METHODS A retrospective study design was used. Between January 2018 and December 2020 we analyzed all pediatric females who underwent explorative surgery with a suspected diagnosis of ovarian torsion, and who were previously evaluated by conventional ultrasound (US), color-Doppler ultrasound (CDUS) and CEUS. RESULTS We examined twenty pediatric females with a median age of 12 years. US identified 9/20 ovarian complex masses against 13/20 by CEUS. At US abdominal free fluid was shown in 13/20 patients and in 18/20 cases with CEUS. In our case series the evaluation of contrast enhancement at CEUS in the detection of ovarian torsions revealed a sensitivity of 94.1%, a specificity of 100% and an overall accuracy of 95%. CONCLUSION Although there is a known ultrasound semeiotics suggestive of ovarian torsion, it is not always possible to obtain a diagnosis of certainty with conventional US even with CDUS. The study reports that complementation with CEUS showed excellent agreement with surgery obtaining a diagnosis in almost all the pediatric females examined.
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Affiliation(s)
- Margherita Trinci
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Marco Di Maurizio
- Department of Radiology, Azienda Ospedaliero-Universitaria Meyer, Largo Piero Palagi, 1, 50139, Florence, Italy
| | - Stefano Tursini
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Vito Briganti
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Michele Galluzzo
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, C.Ne Gianicolense, 87, 00152, Rome, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
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15
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Yatsenko O, Vlachou PA, Glanc P. Predictive Value of Single or Combined Ultrasound Signs in the Diagnosis of Ovarian Torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1163-1172. [PMID: 32941680 DOI: 10.1002/jum.15497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine predictive values of isolated and combined ultrasound signs in the diagnosis of adnexal torsion. METHODS This work was a retrospective study of 129 adult female patients who underwent an ultrasound examination followed by a definitive surgical procedure within a 24-hour period to determine whether adnexal torsion was present. RESULTS The positive predictive value (PPV) of the ultrasound diagnosis of adnexal torsion was 82.2%. The statistically significant ultrasound signs in multivariate logistic regression with single-predictor analyses were relative enlargement of the ovary, an abnormal adnexal position, a twisted vascular pedicle, and the follicular edema "ring sign." Possible combinations of these ultrasound criteria showed high specificities (74%-100%), high PPVs (93%-100%), and lower sensitivities (29%-71%) and negative predictive values (24%-35%). Any combination that included a twisted vascular pedicle or the follicular ring sign as one of the signs had high odds ratios and positive likelihood ratios. CONCLUSIONS Ultrasound has a high PPV as a first-choice imaging modality in the diagnosis of adnexal torsion. The combinations of the following 4 statistically significant ultrasound signs, consisting of an abnormal position, relative enlargement of the index ovary, a twisted vascular pedicle, and the follicular edema ring sign, substantially narrow the imaging differential diagnosis in such cases. The presence of vascular pedicle twisting and the follicular ring sign was highly associated with a positive ovarian torsion diagnosis, with 100% specificity.
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Affiliation(s)
- Oleg Yatsenko
- Department of Radiology, Peterborough Regional Health Center, Peterborough, Ontario, Canada
| | - Paraskevi A Vlachou
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Phyllis Glanc
- University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Body Division, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Kanneganti A, Bhadiraju P, Tong PSY. Extragonadal teratomas in women and adolescent girls: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 262:134-141. [PMID: 34022590 DOI: 10.1016/j.ejogrb.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/10/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs. METHODS We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively. CONCLUSIONS While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.
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Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Poornima Bhadiraju
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Pearl Shuang Ye Tong
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore.
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Henrichsen TL, Maturen KE, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Friedman L, Learman LA, Patlas MN, Sadowski EA, Saphier C, Wasnik AP, Glanc P. ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain. J Am Coll Radiol 2021; 18:S119-S125. [PMID: 33958106 DOI: 10.1016/j.jacr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia, Vice Chair of Research, Department of Radiology, Medstar Georgetown University Hospital
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio, American Congress of Obstetricians and Gynecologists, Director, Center of Endometriosis, Co-director, Chronic Pelvic Pain, Associate Program Director, Fellowship in Minimally Invasive Gynecologic Surgery, Cleveland Clinic
| | - Lucas Friedman
- University of California Riverside, Riverside, California, American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, American Congress of Obstetricians and Gynecologists, Dean, Virginia Tech Carilion School of Medicine
| | - Michael N Patlas
- McMaster University, Hamilton, Ontario, Canada, Editor-in-Chief, Canadian Association of Radiologists Journal
| | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey, American Congress of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain. Abdom Radiol (NY) 2021; 46:1137-1147. [PMID: 32935259 DOI: 10.1007/s00261-020-02761-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To define and weight the preoperative CT findings for ovarian torsion and to develop an integrated nomogram for estimating the probability of ovarian torsion in women with ovarian lesion and pelvic pain. METHODS This retrospective study included 218 women with surgically resected ovarian lesions who underwent preoperative contrast-enhanced CT for pelvic pain from January 2014 to February 2019. Significant imaging findings for torsion were extracted using regression analyses and a regression coefficient-based nomogram was constructed. The diagnostic performance with sensitivity, specificity, and accuracy of the significant imaging findings and the nomogram were assessed. RESULTS A total of 255 ovarian lesions (123 lesions with torsion and 132 lesions without torsion) were evaluated. Multivariable regression analysis showed that whirl sign (odds ratio [OR] 11.000; p < 0.001), tubal thickening (OR 4.621; p = 0.001), unusual location of ovarian lesion (OR 2.712; p = 0.020), and hemorrhagic component within adnexal lesion (OR 2.537; p = 0.028) were independent significant parameters predicting ovarian torsion. Tubal thickening showed the highest sensitivity (91.1%) and whirl sign showed the highest specificity (94.7%). When probabilities of ovarian torsion of 0.5 or more in the nomogram were diagnosed as ovarian torsion, sensitivity, specificity, and accuracy of the nomogram were 78.1%, 91.7%, and 85.1%, respectively. CONCLUSION The whirl sign, tubal thickening, unusual location of ovarian lesion, and hemorrhagic component within adnexal lesion, and an integrated nomogram derived from these significant findings can be useful for predicting ovarian torsion.
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Strachowski LM, Choi HH, Shum DJ, Horrow MM. Pearls and Pitfalls in Imaging of Pelvic Adnexal Torsion: Seven Tips to Tell It's Twisted. Radiographics 2021; 41:625-640. [PMID: 33646910 DOI: 10.1148/rg.2021200122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pelvic adnexal torsion is a collective term referring to twisting of an ovary, fallopian tube, or paraovarian cyst on its axis with varying degrees of vascular compromise. Although it is the fifth most common gynecologic emergency, the diagnosis is challenging and often missed due to symptoms, physical examination findings, and imaging features that are nonspecific. Delay in salvage surgery may lead to ovarian or tubal loss, dysfunction, and infertility. The tips shared herein are based on the authors' observations of key clinical and imaging features of torsion, with the intent of heightening radiologists' index of suspicion and diagnostic accuracy in a clear and memorable fashion. Clinically, severe acute pain with a known adnexal mass or of severity to elicit nausea or vomiting should raise concern. At imaging, features of ovarian edema are key to the diagnosis, including asymmetric ovarian enlargement, peripheralized follicles, adjacent free fluid, and foci of stromal hemorrhage. The converse finding of symmetric nonenlarged ovaries in a normal location with any imaging modality has a high negative predictive value for torsion, obviating the need for additional imaging. The whirlpool sign (twisted vascular pedicle), abnormal ovarian location, and uterine tilting are additional key imaging manifestations. The presence of color Doppler flow or contrast enhancement only suggests that an ovary is still viable and should not be used to exclude the diagnosis of torsion. In cases of isolated tubal or paraovarian cyst torsion, the ovaries may appear normal; therefore, recognition of this entity along with appreciation of several key imaging findings may assist with this difficult diagnosis. An invited commentary by Dighe is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Lori M Strachowski
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Hailey H Choi
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Dorothy J Shum
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
| | - Mindy M Horrow
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (L.M.S., H.H.C., D.J.S.); Department of Radiology, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); and Department of Radiology, Einstein Healthcare Network, Philadelphia, Pa (M.M.H.)
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20
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Novoa M, Friedman J, Mayrink M. Ovarian torsion: can we save the ovary? Arch Gynecol Obstet 2021; 304:191-195. [PMID: 33638663 DOI: 10.1007/s00404-021-06008-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the correlation between visually appearing ovarian necrosis and necrosis in histopathology in patients with ovarian torsion; and to identify predictive factors of ovarian necrosis. METHODS This is a retrospective study. All women admitted to the hospital with a diagnosis of suspected ovarian torsion from January 2014 to December 2018 were recruited. Forty-two patients with a confirmed diagnosis of ovarian torsion were finally included. Correlation analysis was done between visual judgement of ovarian necrosis and necrosis in histopathology. Chi-square was performed to analyze dependence between time from pain onset to surgery, ovarian size in ultrasound, Doppler flow, and histopathological analysis. RESULTS Thirty-one ovaries were visually judged as necrotic. Only five of them (16%) had histopathologically confirmed necrosis, 20 (64.5%) had hemorrhage or congestion, and 6 (19%) had normal ovarian tissue, p = 0.349. Development of ovarian necrosis showed to be dependent on time from onset of pain to surgery. All patients with necrotic ovaries in histopathology underwent surgery after 24 h of pain onset, while there was no necrosis in those who had surgery before 24 h. (p = < 0.05). There was no relationship between ovarian size measured by ultrasound and necrosis (p = 0.265), as well as color flow in ultrasound and necrosis (p = 0.388). CONCLUSION Visual assessment of ovarian necrosis intraoperatively is not a good predictor of real necrosis in histopathology. To preserve the ovary, surgical management should not be delayed.
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Affiliation(s)
- Maria Novoa
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 2701 Biscayne Boulevard, Number 2101, Miami Beach, FL, 33137, USA.
| | - Jonathan Friedman
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maximiliano Mayrink
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 2701 Biscayne Boulevard, Number 2101, Miami Beach, FL, 33137, USA
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Vicente AP, Gomes AS, Jokubkiene L, Sladkevicius P. Ovarian borderline tumor presenting as ovarian torsion in a 17-year-old patient: a case report. J Med Case Rep 2021; 15:7. [PMID: 33436080 PMCID: PMC7802186 DOI: 10.1186/s13256-020-02597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ovarian torsion is a gynecological surgical emergency whose diagnosis remains a challenge. Torsion occurs most frequently in women of reproductive age. It is usually associated with the presence of benign masses in the ovary, as malignant tumors are less frequent and less prone to undergo torsion. Case presentation We report the case of a 17-year-old Caucasian patient who presented to the emergency department with lower abdominal pain. Ultrasonography evaluation revealed a unilateral ovarian lesion, 11.2 cm, with features suspicious for malignancy and torsion. The patient was referred for surgical torsion treatment and underwent unilateral salpingo-oophorectomy. The pathology report confirmed a serous borderline ovarian tumor with torsion. Conclusions Malignant ovarian torsion in pediatric age groups is rare. Ultrasound examination should be recognized as a powerful tool for diagnosis and management, especially when performed by an experienced ultrasonographer.
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Affiliation(s)
- Ana Patrícia Vicente
- Department of Obstetrics and Gynecology, Hospital de Cascais - Dr. José de Almeida, Lisbon, Portugal
| | - Andrea Sousa Gomes
- Department of Obstetrics and Gynecology, Hospital de Cascais - Dr. José de Almeida, Lisbon, Portugal
| | - Ligita Jokubkiene
- Mälmo Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Mälmo, Sweden
| | - Povilas Sladkevicius
- Mälmo Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Mälmo, Sweden.
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The effect of folate on ischemia/reperfusion injury in a rat adnexal torsion model. Arch Gynecol Obstet 2021; 303:1495-1500. [PMID: 33399929 DOI: 10.1007/s00404-020-05934-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The ischemia/reperfusion (I/R) injury of ovaries in adnexal torsion may have inadvertent consequences. Many agents have been studied in terms of their ability to prevent reperfusion damage to ovaries in suspected cases. In this study, folic acid, known to have antioxidative properties, was investigated to determine whether it played a role in the prevention of I/R damage in a rat ovarian torsion model. METHODS In this experimental study, 40 female adult Wistar-Albino rats were randomly divided into five groups as control, ischemia, I/R, Fol2 (2 mg/kg folic acid), and Fol4 (4 mg/kg folic acid). In the Fol2 and Fol4 groups, folic acid was intraperitonelly administered 30 min before reperfusion. Blood samples were obtained from the tails of each rat at the second hour of reperfusion. RESULTS The total oxidant status (TOS), total antioxidant status, cystatin C and folic acid levels of the five groups were investigated. Folic acid in 2 mg/kg dose could moderately increase the serum folic acid concentration (15.75-19.95 ng/ml, p < 0.05), reduce the level of cystatin C (0.18-0.12 μg/L, p < 0.05), and had a tendency to improve the oxidative stress injury (OSI: 76.05-33.06, p > 0.05), although there was no statistical difference in TOS levels (p = 0.07). Folic acid in 4 mg/kg dose, could significantly increase the serum folic acid concentration (15.75-37.65 ng/ml). However, it did not significantly reduce the level of cystatin C (0.18-0.19 μg/L, p > 0.05), and did not improve oxidative stress injury (76.05-130.58, p > 0.05). CONCLUSION Folic acid in 2 mg/kg dose might improve the ovarian I/R injury though this was not statistically significant. Further studies are required to reach a definitive conclusion about the protective effect of folic acid in I/R injury.
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Bardin R, Perl N, Mashiach R, Ram E, Orbach-Zinger S, Shmueli A, Wiznitzer A, Hadar E. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:688-694. [PMID: 31703238 DOI: 10.1055/a-1014-2593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. MATERIALS AND METHODS Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. RESULTS The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). CONCLUSION Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.
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Affiliation(s)
- Ron Bardin
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Noga Perl
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Reuven Mashiach
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Ram
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | | | - Anat Shmueli
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Arnon Wiznitzer
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Hadar
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
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24
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Moro F, Bolomini G, Sibal M, Vijayaraghavan SB, Venkatesh P, Nardelli F, Pasciuto T, Mascilini F, Pozzati F, Leone FPG, Josefsson H, Epstein E, Guerriero S, Scambia G, Valentin L, Testa AC. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:934-943. [PMID: 31975482 DOI: 10.1002/uog.21981] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the clinical and ultrasound characteristics of adnexal torsion. METHODS This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ. RESULTS A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1-88) years. Most patients were premenopausal (284/314; 90.4%) and presented with acute or subacute pelvic pain (305/315; 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167/241 (69.3%) patients, the whirlpool sign in 178/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119/269 (44.2%) patients and the follicular ring sign in 51/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201/254; 79.1%) and the whirlpool sign (139/153; 90.8%) were the most commonly detected features of adnexal torsion. CONCLUSION Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Bolomini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - M Sibal
- Department of Fetal Medicine and Obstetric and Gynecologic Ultrasound, Manipal Hospital, Bangalore, India
| | | | - P Venkatesh
- Department of Fetal Medicine and OBGYN Ultrasound, Manipal Hospital, Bangalore, India
| | - F Nardelli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Institute for Women's Health, University College Hospital, London, UK
| | - T Pasciuto
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Pozzati
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F P G Leone
- Department of Obstetrics and Gynecology, Biomedical and Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - H Josefsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - A C Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG 2020; 128:37-44. [PMID: 32570294 DOI: 10.1111/1471-0528.16371] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adnexal torsion (AT), a serious gynaecological emergency, often presents with non-specific symptoms leading to delayed diagnosis. OBJECTIVE To compare the test accuracy of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose AT. SEARCH STRATEGY We searched EMBASE, MEDLINE and Cochrane CENTRAL until December 2019. SELECTION CRITERIA Studies reporting on the accuracy of any imaging modality (Index Test) in female patients (paediatric and adult) suspected of AT compared with surgical diagnosis and/or standard clinical/radiological follow-up period until resolution of symptoms (Reference Standard). DATA COLLECTION AND ANALYSIS We assessed study quality using QUADAS-2. We conducted test accuracy meta-analysis using a univariate model or a hierarchical model. MAIN RESULTS We screened 3836 citations, included 18 studies (1654 women, 665 cases), and included 15 in the meta-analyses. Ultrasound pooled sensitivity (n = 12, 1187 women) was 0.79 (95% CI 0.63-0.92) and specificity was 0.76 (95% CI 0.54-0.93), with negative and positive likelihood ratios of 0.29 (95% CI 0.13-0.66) and 4.35 (95% CI 2.03-9.32), respectively. Using Doppler with ultrasound (n = 7, 845 women) yielded similar sensitivity (0.80, 95% CI 0.67-0.93) and specificity (0.88, 95% CI 0.72-1.00). For MRI (n = 3, 99 women), the pooled sensitivity was 0.81 (95% CI 0.63-0.91) and specificity was 0.91 (95% CI 0.80-0.96). A meta-analysis for CT was not possible with two case-control studies and one cohort study (n = 3, 232 women). Its sensitivity range was 0.74-0.95 and specificity was 0.80-0.90. CONCLUSIONS Ultrasound has good performance as a first-line diagnostic test for suspected AT. Magnetic resonance imaging could offer improved specificity to investigate complex ovarian morphology, but more evidence is needed. TWEETABLE ABSTRACT To investigate adnexal torsion, ultrasound is a good first-line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76.
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Affiliation(s)
- B Wattar
- West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - M Rimmer
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - E Rogozinska
- MRC Clinical Trials Unit, University College London, London, UK
| | - M Macmillian
- MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
| | - K S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - B H Al Wattar
- Warwick Medical School, University of Warwick, Coventry, UK
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Balica A, Kohut A, Tsai TJ, Groszmann YS, Brandt JS. A Bibliometric Analysis of Citation Classics in the Journal of Ultrasound in Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1289-1297. [PMID: 31944354 DOI: 10.1002/jum.15220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A bibliometric analysis of articles in the Journal of Ultrasound in Medicine (JUM) identified the journals' most impactful articles. METHODS A bibliometric analysis of citation classics that were published in the JUM from its inception in 1982 to 2019 was performed. All citation classics, defined as articles cited 100 or more times, were evaluated for the number of citations, citations per year, publication year, subspecialty, design, and country of origin. Characteristics were compared before and after 1998 by the Mann-Whitney test for unpaired data and 2-sample z tests of sample proportions. The Kruskal-Wallis test for nonparametric continuous data was used to compare the median number of citations per year by decade of publication. RESULTS A total of 7868 articles were published in the JUM between 1982 and 2019; 54 (0.7%) were citation classics. The median citation classics year of publication was 1998 (interquartile range [IQR], 1991-2003). Most citation classics originated from the United States (36 of 54 [66.7%]), were observational (47 of 54 [87%]), and were related to obstetric and gynecologic topics (16 of 54 [29.6%]). Citation classics after 1998 received significantly more citations per year (9.3 versus 4.7; P < .001), with no other differences noted. The median number of citations per year increased for each decade, with medians of 4 citations (IQR, 3.6-4.7) in 1982 to 1991 and 11.2 citations (IQR, 9-13.9) in 2002 to 2012 (P < .001). CONCLUSIONS This list provides insight into the most influential articles that were published in the JUM. Most citation classics were observational, were from the United States, and covered obstetric and gynecologic topics. Citation classics received more citations per year after 1998.
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Affiliation(s)
- Adrian Balica
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Adrian Kohut
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Te-Jung Tsai
- Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yvette S Groszmann
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Diagnostic Ultrasound Associates, Brookline, Massachusetts, USA
| | - Justin S Brandt
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Richardson A, Brigic A, Emmett J, Natale J, Baskind NE. Going, gonad, gone. Gender inequalities in the management of gonadal torsion: a cohort study. HUM FERTIL 2020; 25:247-255. [PMID: 32590926 DOI: 10.1080/14647273.2020.1784473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Gonadal torsion (when the gonad twists on its ligamentous supports) is a surgical emergency in both men and women. Prompt management is essential to preserve gonadal function. Our aim was to compare the timeliness with which men and women who underwent surgery for suspected gonadal torsion are managed. All adult patients who underwent surgery for suspected gonadal torsion between 1/4/16 and 31/3/18 were reviewed and the following times recorded: symptom onset; hospital presentation; gynaecological/surgical review; decision for theatre; and knife-to-skin (KTS). The surgical procedure(s) and intra-operative findings were also documented. In total, 31 women (mean age 29.4 ± 7.1yrs) and 49 men (mean age 23.2 ± 7.0yrs) were identified. Women waited significantly longer than men at every stage (p < 0.01). Time intervals between hospital presentation and review, review and decision for theatre, and decision and KTS were 1.6 (1.2-2.6 hrs), 0.3 (0.0-0.9 hrs) and 1.7 (1.5-2.5 hrs) for men and 4.3 (3.1-15.3 hrs), 10.3 hrs (2.4-20.7 hrs) and 4.7 (2.3-9.3 hrs) for women, respectively. Torsion was confirmed in 20 (64.5%) women and 25 (51.0%) men. Intraoperatively, 13(65%) ovaries were reportedly necrotic compared to only 6 (24%) testes (p = 0.0076). All necrotic gonads were removed despite conservative surgery being recommended practice during the study period. Women with suspected gonadal torsion received suboptimal care compared to their male counterparts, which has potentially catastrophic consequences for the subsequent fertility of this predominantly young population.
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Affiliation(s)
- Alison Richardson
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Adela Brigic
- Department of Surgery, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Jack Emmett
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Joseph Natale
- Department of Surgery, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - N Ellissa Baskind
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
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28
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Jung SI, Park HS, Jeon HJ, Yu MH, Kim YJ, Chung J, Jeong K. Whirlpool sign of adnexal torsion on CT: where can we find it? Acta Radiol 2020; 61:714-720. [PMID: 31569947 DOI: 10.1177/0284185119877336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Whirlpool sign on computed tomography (CT) is pathognomic of adnexal torsion. Purpose To evaluate the visibility and common location of the whirlpool sign in adnexal torsion on CT. Material and Methods This retrospective study included 143 consecutive patients who underwent preoperative CT imaging and subsequent surgically confirmed as adnexal torsion. Two readers independently recorded the presence and location of whirlpool sign in adnexal torsion on CT. Patients with and without whirlpool sign were compared with regard to the size of the adnexal mass and the degree of torsion. Results Whirlpool sign was detected in 60 (42.0%) patients on the transverse CT plane and 79 (55.2%) patients on the coronal CT plane of 143 patients. The sign was significantly better detected on the coronal CT plane than on the transverse CT plane ( P = 0.03). The most common location of the sign included the posterolateral aspect of the adnexal mass on the transverse CT plane (25/60, 41.7%, P = 0.04) and the upper-lateral aspect of the adnexal mass on the coronal CT plane (45/79, 60.0%, P < 0.001). The size of the adnexal mass with whirlpool sign was significantly larger than the mass without whirlpool sign on the transverse CT plane (median 9.6 vs. 8.6 cm, P = 0.03). No significant difference in the degree of torsion was found between patients with and without whirlpool sign on CT ( P = 0.56–0.62). Conclusion Whirlpool sign of adnexal torsion is well detected at the upper-lateral aspect of adnexal mass on the coronal CT plane.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Jieun Chung
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul, Republic of Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Ovarian torsion: developing a machine-learned algorithm for diagnosis. Pediatr Radiol 2020; 50:706-714. [PMID: 31970456 DOI: 10.1007/s00247-019-04601-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/21/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. Ultrasound is the mainstay of evaluation for ovarian torsion in the pediatric population. However, even with a high index of suspicion, imaging features are not pathognomonic. OBJECTIVE We sought to develop an algorithm to aid radiologists in diagnosing ovarian torsion using machine learning from sonographic features and to evaluate the frequency of each sonographic element. MATERIALS AND METHODS All pediatric patients treated for ovarian torsion at a quaternary pediatric hospital over an 11-year period were identified by both an internal radiology database and hospital-based International Statistical Classification of Diseases and Related Health Problems (ICD) code review. Inclusion criteria were surgical confirmation of ovarian torsion and available imaging. Patients were excluded if the diagnosis could not be confirmed, no imaging was available for review, the ovary was not identified by imaging, or torsion involved other adnexal structures but spared the ovary. Data collection included: patient age; laterality of torsion; bilateral ovarian volumes; torsed ovarian position, i.e. whether medialized with respect to the mid-uterine line; presence or absence of Doppler signal within the torsed ovary; visualization of peripheral follicles; and presence of a mass or cyst, and free peritoneal fluid. Subsequently, we evaluated a non-torsed control cohort from April 2015 to May 2016. This cohort consisted of sequential girls and young adults presenting to the emergency department with abdominopelvic symptoms concerning for ovarian torsion but who were ultimately diagnosed otherwise. These features were then fed into supervised machine learning systems to identify and develop viable decision algorithms. We divided data into training and validation sets and assessed algorithm performance using sub-sets of the validation set. RESULTS We identified 119 torsion-confirmed cases and 331 torsion-absent cases. Of the torsion-confirmed cases, significant imaging differences were evident for girls younger than 1 year; these girls were then excluded from analysis, and 99 pediatric patients older than 1 year were included in our study. Among these 99, all variables demonstrated statistically significant differences between the torsion-confirmed and torsion-absent groups with P-values <0.005. Using any single variable to identify torsion provided only modest detection performance, with areas under the curve (AUC) for medialization, peripheral follicles, and absence of Doppler flow of 0.76±0.16, 0.66±0.14 and 0.82±0.14, respectively. The best decision tree using a combination of variables yielded an AUC of 0.96±0.07 and required knowledge of the presence of intra-ovarian flow, peripheral follicles, the volume of both ovaries, and the presence of cysts or masses. CONCLUSION Based on the largest series of pediatric ovarian torsion in the literature to date, we quantified sonographic features and used machine learning to create an algorithm to identify the presence of ovarian torsion - an algorithm that performs better than simple approaches relying on single features. Although complex combinations using multiple-interaction models provide slightly better performance, a clinically pragmatic decision tree can be employed to detect torsion, providing sensitivity levels of 95±14% and specificity of 92±2%.
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KARAKAŞ S, KAYA C, GÜRASLAN H, SAKIZ D, SÜZEN ÇAYPINAR S, CENGİZ H, EKİN M, YAŞAR L. Effect of metformin and detorsion treatment on serum anti-Müllerian hormonelevels and ovarian histopathology in a rat ovarian torsion model. Turk J Med Sci 2020; 50:455-463. [PMID: 31999406 PMCID: PMC7164755 DOI: 10.3906/sag-1803-196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background/aim Adnexal torsion is a common gynaecological emergency, and considered to be a problem mostly in reproductive-age women. To evaluatethe effect of metformin and detorsion treatment on reducing ovarian reserve in an ovarian torsion model. Materials and methods Twenty-four nonpregnant, Wistar Hannover rats were included in the study. Animals were divided into 3 groups: the control group, the detorsion only group, and the metformin + detorsion group. The first group received only laparotomy. In the second group, ovaries were fixed to the abdominal wall after performing 360° ovarian torsion, followed by detorsion after a 3-h period of ischemia. The third group underwent the same torsion and detorsion procedures as the second group, and received 50 mg/kg metformin by gavage for 14 days. Ovarian damage scores, follicle counts, and AMH levels were evaluated. Results The total damage score was significantly increased in the detorsion only group compared to the metformin+detorsion and control groups. Pre-operative/post-operative AMH decreases were statistically significant in negative direction in the detorsion only group when compared to the metformin+detorsion and control groups (P = 0.001). Conclusion Metformin+detorsion treatment may be effective in protecting the ovarian reserve after ovarian torsion.
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Affiliation(s)
- Sema KARAKAŞ
- Department of Obstetrics and Gynecology, University of Health Sciences,Gaziosmanpaşa Taksim Training and Research Hospital, İstanbulTurkey
| | - Cihan KAYA
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Hakan GÜRASLAN
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Damlanur SAKIZ
- Department of Pathology, University of Health Sciences,Bakirköy Dr Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Sema SÜZEN ÇAYPINAR
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Hüseyin CENGİZ
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Murat EKİN
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Levent YAŞAR
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
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Topcu A, Balik G, Atak M, Mercantepe T, Uydu HA, Tumkaya L. An investigation of the effects of metformin on ovarian ischemia-reperfusion injury in rats. Eur J Pharmacol 2019; 865:172790. [PMID: 31730761 DOI: 10.1016/j.ejphar.2019.172790] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/08/2023]
Abstract
Damage to the ovaries or tissue torsion can significantly reduce the ovarian reserve and thus cause severe gynecological and hormonal deficiencies. The discovery of new agents is always needed in the treatment of this condition. Metformin (MET) has been shown to be beneficial in attenuating ovarian ischemia-reperfusion injury. Fifty-six female Sprague Dawley rats were divided into seven groups. Group 1 represented the control group (C), Group 2, the ischemia group (I), and Group 3, the ischemia/reperfusion group (I/R). Group 4, the ischemia (I)+250 group, and Group 5, the ischemia (I)+500 group, received 250 mg/kg and 500 mg/kg MET, respectively. Group 6, the ischemia/reperfusion (I/R)+250 group, and Group 7, the ischemia/reperfusion (I/R)+500 group, received 250 mg/kg and 500 mg/kg MET, respectively. Tissue malondialdehyde (MDA), glutathione (GSH), and tumor necrosis factor-alpha (TNF-α) levels in ovarian tissue increased following I/R, while estradiol (E2) levels decreased. Moreover, infiltration and diffuse edematous areas were observed in addition to diffuse vascular congestion and hemorrhage findings. Caspase-3 and nuclear factor kappa B (NF-κβ) expression levels also increased. MDA and TNF-α concentrations decreased in the MET treatment groups, while GSH and E2 levels increased. The findings showed that I/R causes ovarian damage through the induction of oxidative stress, inflammation, and apoptosis. However, MET application was effective in preventing damage in ovarian tissue by reducing levels of reactive oxygen species, proinflammatory cytokines, caspase-3 and NF-κβ.
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Affiliation(s)
- Atilla Topcu
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Pharmacology, 53100, Rize, Turkey.
| | - Gulsah Balik
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Gynecology and Obstetrics, 53100, Rize, Turkey
| | - Mehtap Atak
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Medical Biochemistry, 53100, Rize, Turkey
| | - Tolga Mercantepe
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Histology and Embryology, 53100, Rize, Turkey
| | - Huseyin Avni Uydu
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Medical Biochemistry, 53100, Rize, Turkey
| | - Levent Tumkaya
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Histology and Embryology, 53100, Rize, Turkey
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Bromley B. Gynecologic Ultrasound Evaluation of the Nongravid Woman with Pelvic Pain. Obstet Gynecol Clin North Am 2019; 46:581-594. [PMID: 31677743 DOI: 10.1016/j.ogc.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pelvic pain is a common condition. Many underlying gynecologic and nongynecologic conditions can contribute to this symptom. Pelvic ultrasound using comprehensive 2-dimensional interactive imaging techniques as well as color Doppler and 3-dimensional imaging optimizes the detection of inciting etiologies.
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Affiliation(s)
- Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Diagnostic Ultrasound Associates, One Brookline Place, Suite 506, Brookline, MA 02445, USA
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Naffaa L, Barakat A, Baassiri A, Atweh LA. Imaging Acute Non-Traumatic Abdominal Pathologies in Pediatric Patients: A Pictorial Review. J Radiol Case Rep 2019; 13:29-43. [PMID: 31558965 DOI: 10.3941/jrcr.v13i7.3443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The dilemma of acute non-traumatic abdominal pathologies in the pediatric population depends on the age of the patients and symptoms. Surgical etiologies in patients younger than 2 years of age include intussusception, pyloric stenosis, malrotation and midgut volvulus. In older patients, considerations become closer to differential etiologies in adults including acute appendicitis. Ultrasound and fluoroscopic examinations remain the mainstay for diagnosis that may even be therapeutic such as contrast/air enemas in intussusception reduction. There is an increasing role for CT in appendicitis and renal colic especially in assessing complications; however, it is less favored because it incurs radiation to the patient. This article summarizes the imaging approach to pediatric patients with acute abdominal pathologies presenting to the emergency department, and how imaging is instrumental in guiding diagnosis and treatment, with emphasis on radiation safety, in the context of providing typical imaging findings of each pathology in this pictorial review.
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Affiliation(s)
- Lena Naffaa
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrew Barakat
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amro Baassiri
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lamya Ann Atweh
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Raman Patil A, Nandikoor S, Chaitanya Reddy S. CT in the diagnosis of adnexal torsion: a retrospective study. J OBSTET GYNAECOL 2019; 40:388-394. [DOI: 10.1080/01443615.2019.1633514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of unusual lesions and complications associated with ovarian mature cystic teratoma. Clin Imaging 2019; 57:115-123. [DOI: 10.1016/j.clinimag.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022]
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Kanayama S, Kaniwa H, Tomimoto M, Zhang B, Nishioka K, Oi H. Laparoscopic detorsion of the ovary in ovarian hyperstimulation syndrome during the sixth week of gestation: A case report and review. Int J Surg Case Rep 2019; 59:50-53. [PMID: 31103953 PMCID: PMC6599433 DOI: 10.1016/j.ijscr.2019.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 11/13/2022] Open
Abstract
Delayed treatment & diagnosis of ovarian torsion may cause pregnancy termination. Optimal management for these patients remains unstandardized. No consensus exists regarding the appropriate surgical approach. A 40-year-old pregnant female presented to us with ovarian torsion and OHSS. She was successfully treated with laparoscopic detorsion.
Introduction Ovarian torsion in ovarian hyperstimulation syndrome (OHSS) is a relatively rare but serious complication in pregnant women. A delay in treatment increases the risk for functional loss of the ovary and early termination of pregnancy. In this report, we present the case of a 40-year-old female with OHSS who experienced ovarian torsion that was successfully treated with laparoscopic detorsion. Presentation of case A 40-year-old pregnant woman in the 6th week of gestation who had conceived following in vitro fertilization presented to us with severe and persistent lower abdominal pain. Ultrasound examination revealed a viable singleton intrauterine pregnancy and bilateral enlarged ovaries with scanty ascites. Approximately 14 h after symptom onset, exploratory laparoscopy was performed. The right ovary was found to be twisted once around over the pedicle, and laparoscopic detorsion was completed. Postoperative follow-up was uneventful, and she successfully delivered a healthy infant at 38 weeks of gestation. Discussion Although the reports on successful laparoscopic surgery for pregnant women with ovarian torsion are becoming more frequent, there are few reports on laparoscopic surgery for ovarian torsion in OHSS during the early first trimester. Optimal management of ovarian torsion during pregnancy needs to be explored for these patients. Conclusion Immediate explorative laparoscopic surgery is a potentially safe and useful strategy for treating ovarian torsion during the early first trimester of pregnancy.
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Affiliation(s)
- Seiji Kanayama
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan.
| | - Hiroko Kaniwa
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Masako Tomimoto
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Bo Zhang
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Kazuhiro Nishioka
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Hidekazu Oi
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
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Abstract
Developments in magnetic resonance imaging have expanded its role in the assessment of the female pelvis, including the diagnosis of ovarian lesions. In this setting, diffusion-weighted imaging has proven its diagnostic value, which is particularly important in differentiating between benign and malignant ovarian tumors. In general, the latter show restricted diffusion, whereas the former do not. Exceptions include teratomas, endometriomas, hemorrhagic cysts, ovarian abscesses, ovarian infarction, and some benign stromal tumors. The aim of this review is to draw attention to benign ovarian lesions with restricted diffusion, with a special focus on diffusion-weighted imaging pearls and pitfalls.
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Affiliation(s)
| | - Mariana Horta
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - João Cunha Salvador
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
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Balci O, Energin H, Görkemli H, Acar A. Management of Adnexal Torsion: A 13-Year Experience in Single Tertiary Center. J Laparoendosc Adv Surg Tech A 2019; 29:293-297. [DOI: 10.1089/lap.2018.0307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Osman Balci
- Department of Obstetric and Gynecology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hasan Energin
- Department of Obstetric and Gynecology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hüseyin Görkemli
- Department of Obstetric and Gynecology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ali Acar
- Department of Obstetric and Gynecology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Abstract
Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain in these women, including ovarian hemorrhage, ovarian torsion, pelvic inflammatory disease, endometriosis (particularly deeply infiltrating endometriosis), endometriomas, adenomyosis, pelvic congestion syndrome, and malpositioned intrauterine contraceptive devices. Sonographic observations regarding a number of non-gynecologic causes of pelvic pain are also described.
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Affiliation(s)
- Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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41
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Budhram G, Elia T, Dan J, Schroeder M, Safain G, Schlech W, Friderici J, Knee A, Anthouard M, Schoenfeld E. A Case-Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain. Acad Emerg Med 2019; 26:152-159. [PMID: 30044031 DOI: 10.1111/acem.13523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Color and power Doppler ultrasound are commonly used in the evaluation of ovarian torsion but are unreliable. Because normal-sized ovaries are unlikely to cause torsion, maximum ovarian diameter (MOD) could theoretically be used as a screening test in the ED. Identification of MOD values below which torsion is unlikely would be of benefit to providers interpreting radiology department or point-of-care pelvic ultrasound. OBJECTIVES The objective was to determine if sonographic MOD can be used as a screening tool to rule out torsion in selected patients. METHODS Via a retrospective case-control study spanning a 14-year period, we examined the ultrasound characteristics of patients with torsion and age-matched controls, all presenting to the emergency department with lower abdominal pain and receiving a radiology department pelvic ultrasound for "rule-out torsion." Standardized data collection forms were utilized. Distributions of MOD were compared and sensitivity, specificity, and likelihood ratios were calculated for multiple cutoffs. RESULTS We identified 92 cases of surgically confirmed ovarian torsion and selected 92 age-matched controls. In postmenarchal patients the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 3- and 5-cm MODs were 100% (96%-100%), 30% (20%-41%), 1.4 (1.3-1.7), and 0 and 91% (83%-97%), 92% (83%-97%), 11.2 (5.5-22.9), and 0.09 (0.04-0.19), respectively. The 5-cm MOD, however, excluded an additional 52 of 84 (62%) postmenarchal patients. CONCLUSIONS A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.
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Affiliation(s)
- Gavin Budhram
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Tala Elia
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Jeff Dan
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Michele Schroeder
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Golien Safain
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Cambridge Health Alliance Cambridge MA
| | - Walter Schlech
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Berkshire Medical Center Pittsfield MA
| | - Jennifer Friderici
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Alex Knee
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Magalie Anthouard
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Manatee Memorial Hospital Bradenton FL
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
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Hirshberg B, Rheinboldt M. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emerg Radiol 2019; 26:205-219. [PMID: 30631995 DOI: 10.1007/s10140-018-01665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
Over the past 40 years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.
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Gu X, Yang M, Liu Y, Liu F, Liu D, Shi F. The ultrasonic whirlpool sign combined with plasma d-dimer level in adnexal torsion. Eur J Radiol 2018; 109:196-202. [DOI: 10.1016/j.ejrad.2018.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/09/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
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Thimm MA, Rhee D, Takemoto CM, Karnsakul W, Cuffari C, Guerrerio AL, Garcia A, Gearhart J, Huisman TAGM, Hwang M. Diagnosis of congenital and acquired focal lesions in the neck, abdomen, and pelvis with contrast-enhanced ultrasound: a pictorial essay. Eur J Pediatr 2018; 177:1459-1470. [PMID: 29971555 DOI: 10.1007/s00431-018-3197-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/30/2018] [Accepted: 06/19/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED Contrast-enhanced ultrasound (CEUS) is a versatile imaging modality that improves the diagnostic potential of conventional ultrasound. It allows for portable imaging at the bedside. In this paper, we illustrate how CEUS can be used in evaluating several focal lesions in the pediatric population, including liver hemangioma, telangiectasias, splenic hamartomas, and bladder lesions. We describe the ultrasound findings and contrast enhancement patterns associated with these lesions. Findings are correlated with MRI, CT, and/or pathology when available. This paper demonstrates the value of CEUS in improving characterization of many focal lesions in the pediatric population. CONCLUSION CEUS is a valuable bedside technique for use in the pediatric population to evaluate focal lesions in various organs, and will allow for safe, more efficient diagnostic imaging. What is Known: • CEUS offers many advantages over CT and MRI and is underutilized in the United States. • It is only FDA approved for vesicoureteral reflux and liver in the pediatric population. However, off label uses are well described. What is New: • This pictorial essay describes ultrasound findings and contrast enhancement patterns associated with liver hemangioma, liver telangiectasia, splenic hamartoma, hemorrhagic ovarian cyst, urachal remnant, spinning top urethras, and kaposiform hemangioendothelioma. • We demonstrate the utility of CEUS in expanding the diagnostic potential of conventional ultrasound.
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Affiliation(s)
- Matthew A Thimm
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Rhee
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clifford M Takemoto
- Division of Pediatric Hematology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carmen Cuffari
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alejandro Garcia
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Gearhart
- Division of Pediatric Urology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Günay T, Yardımcı OD, Hocaoğlu M, Demirçivi Bör E, Erdem G. Over Torsiyonu ve Cerrahi Tedavisi: Tersiyer bir merkezin 5 yıllık deneyimi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2018. [DOI: 10.17517/ksutfd.423102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lee MS, Moon MH, Woo H, Sung CK, Oh S, Jeon HW, Lee TS. CT findings of adnexal torsion: A matched case-control study. PLoS One 2018; 13:e0200190. [PMID: 29995921 PMCID: PMC6040737 DOI: 10.1371/journal.pone.0200190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/21/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The purpose of our study was to assess computed tomographic (CT) findings of adnexal torsion through a matched case-control analysis. Materials and methods This retrospective, single-institution case-control study included 43 women with adnexal torsion and 43 age- and ovarian mass-matched control women. CT images were evaluated independently by two readers for the following: prominent peripheral follicles, uterine deviation, thickened pedicles, a whirl sign, and a navel sign. Comparisons of CT findings were performed using the Chi square test and receiver operating characteristic (ROC) curves were obtained to assess the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared by using a Delong test. Results The CT findings significant for adnexal torsion were uterine deviation toward the side of the affected ovary (P = < .01 for reader 1 and P = .02 for reader 2) and thickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles (P < .01 for both readers). Thickened pedicles with ancillary findings had the highest diagnostic accuracy, as measured with ROC curves (AUC, 0.86 in reader 1 and 0.85 in reader 2). Combining uterine deviation toward the side of the affected ovary with thickened pedicles with ancillary findings did not increase the performance relative to that of thickened pedicles with ancillary findings alone. Conclusions Thickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles could be helpful for the diagnosis of adnexal torsion.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Hyunsik Woo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyu Sung
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Jeon
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Grunau GL, Harris A, Buckley J, Todd NJ. Diagnosis of Ovarian Torsion: Is It Time to Forget About Doppler? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:871-875. [DOI: 10.1016/j.jogc.2017.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 10/17/2022]
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Diagnostic performance of CT signs for predicting adnexal torsion in women presenting with an adnexal mass and abdominal pain: A case-control study. Eur J Radiol 2018; 98:75-81. [DOI: 10.1016/j.ejrad.2017.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
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Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric Ovarian Torsion: Spectrum of Imaging Findings. Radiographics 2017; 37:1892-1908. [DOI: 10.1148/rg.2017170026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Akosua Sintim-Damoa
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Anand Shyamcharan Majmudar
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Harris L. Cohen
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Louis Swig Parvey
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
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Jourjon R, Morel B, Irtan S, Audureau E, Coulomb-L'Herminé A, Larroquet M, Ducou le Pointe H, Blondiaux E. Analysis of Clinical and Ultrasound Determinants of Adnexal Torsion in Children and Adolescents. J Pediatr Adolesc Gynecol 2017; 30:582-590. [PMID: 28396218 DOI: 10.1016/j.jpag.2017.03.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE We aimed to assess the performance of transabdominal ultrasonography (US) for diagnosis of adnexal torsion (AT) in children and adolescents and evaluate its clinical and US determinants. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We retrospectively (2004-2014) studied data for children referred for acute or subacute pelvic pain who underwent US and included children 3 months to 18 years old who underwent surgical exploration and/or clinical and radiological follow-up for at least 3 months. The evaluation of US diagnostic performance was on the basis of the proposed diagnosis after US: AT or no AT with or without mass. Clinical and US predictors of AT were identified using regression analysis. RESULTS Among 65 girls included (mean age 11.75 ± 4.49 years), 33 (50.8%) had AT. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US for AT were 90.9%, 68.7%, 75%, 88%, and 80%, respectively. Overall, 20 of 33 (60.6%) AT patients had a mass, including 33% with mature teratomas. Patients with AT versus no AT more frequently showed vomiting (64% vs 28%; P = .008), ovarian edematous stroma with a peripheral distribution of follicles (45.5% vs 9.4%; P = .002) and a mass of pluritissular aspect (40% vs 0%; P < .0001). The quantitative US predictors of AT were total area ratio (ovary and mass)/area of the contralateral ovary 4.9 or greater (P = .0002) and surface area 18.5 cm2 or greater (P = .0003). CONCLUSION US has high sensitivity but low specificity for the diagnosis of AT in children. The predictive criteria are vomiting, presence of a pluritissular mass, 4.9 area ratio or greater, or surface area 18.5 cm2 or greater.
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Affiliation(s)
- Rebecca Jourjon
- Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Baptiste Morel
- Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Sabine Irtan
- Department of Surgery, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Etienne Audureau
- Public Health Department, Hôpital Henri Mondor (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Aurore Coulomb-L'Herminé
- Department of Pathology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Michèle Larroquet
- Department of Surgery, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Hubert Ducou le Pointe
- Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France
| | - Eléonore Blondiaux
- Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
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